An emerging drug threat: Fighting xylazine and fentanyl

Original article here.

Xylazine is popping up across the country, primarily detected after being mixed with opioids like fentanyl. The drug is typically used a tranquilizer or sedative for horses.

Tuesday, The White House’s Office of National Drug Control Policy released a six-point plan, with the hopes of addressing the deadly combination.

The plan focuses on six pillars of action: testing, data collection, evidence-based prevention, harm reduction, and treatment, supply reduction, scheduling and research.

“Now, with this National Response Plan, we are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety, and save lives,” ONDCP Director Dr. Gupta said in a news release.

Since its only FDA approval is as a veterinary sedative, it’s not been widely tested for or even researched.

“We usually don’t know what’s in the drug supply until it’s too late, either when people are arrested or they’re dead,” Nabarun Dasgupta said.

Both Dasgupta and Colin Miller have studied drugs and overdose prevention for more than 35 years combined. Their work at the UNC Street drug analysis lab has opened the door of exploration on Xylazine, also known as “Tranq.”

“What we really need to do is have a real time view of what the street drug supply is in order to be able to prevent the health harms that we’re seeing in our communities,” Dasgupta, the senior scientist for the analysis lab, said. “We’ve seen it in urban areas, we’ve seen it in rural areas, we’ve seen it in the western parts of the state, out to the coast.”

Through the analysis lab, researchers test street drugs from 30+ North Carolina harm reduction programs, hospitals, clinics and health departments. Xylazine has been discovered in 18 counties in the state, including Wake, Durham, Cumberland and Robeson counties.

“The problem with the addition to fentanyl is that it can cause serious cardiovascular problems in people, as well as sedation. Cardiovascular problems are related to increase in blood pressure, slow heart rate, and some arrhythmias. Although overdose of fentanyl (or heroin) can be reversed with naloxone (Narcan), xylazine acts on entirely different receptors in the body. It is not reversed by naloxone; therefore, the effects can persist even after reversal with naloxone,” Dr. Mark Papich, a professor of clinical pharmacology at North Carolina State University, explained.

Papich added while there are reversal agents for xylazine, it’s unlikely you’ll find them at a hospital.

“It is unlikely that hospital emergency rooms stock these reversal agents because they are only used by veterinarians,” Papich explained.

Papich said it’s not clear where the supply of Xylazine is coming from.

Dasgupta still highly recommends people keep Narcan on hand.

“Our advice is very clear: keep using the Naloxone or Narcan to reverse overdoses because first of all, all the xylazine that we’re seeing in North Carolina is found with fentanyl. The Naloxone or Narcan will work on the fentanyl. And that’s the most potent part of it,” he said.

The Drug Enforcement Administration warned communities of the deadly combination. In 2022, roughly 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained Xylazine.

“This is something that we can deal with as a community. I think we shouldn’t panic about this; the drug supply is always going to change. And this is one more thing that we have been fortunate enough to be ahead of the curve in North Carolina and figuring out solutions,” Dasgupta said.